It's Wheezin' Season
In a general pediatric practice, the fall and winter season is a nonstop dance of infectious diseases: colds, ear infections, pneumonia, and influenza. The onset of warmer weather coincides with a decrease in these illnesses, and a well-deserved break in the number of patients I see per day. Not this year...
Because spring in Northern California was delayed due to one of the wettest years on record, we made a jump in one week from infectious diseases to children with allergy. Earlier in the week, the runny noses started. The waiting room was filled with raccoon-eyed toddlers doing the "allergic salute". The allergic salute is a characteristic upward hand wipe of an itchy, runny nose. The raccoon eyes are also called "allergic shiners" - a bluish discoloration around the itchy, tearing eyes due to constant rubbing. Children have an itchy flair-up of eczema (atopic dermatitis). And, of course, the distinct sound of wheezing. When a person has itchy eyes, runny / itchy nose, AND audible wheezing, it has to be an allergic disorder.
All that wheezes is not necessarily asthma. Even simple viral infections (colds) can cause wheezing. An inhaled foreign body (not uncommon in children) can do it. Pneumonia and RSV (Respiratory Syncytial Virus) can do it. As a matter of fact, if you had a child that had RSV in infancy, this child has an increased risk of developing asthma.
Allergies and asthma runs in families, it is not unusual to see BOTH the child and the parent snorting, sneezing, and sniffing in perfect harmony. If one parent has asthma, the child has a 20% chance of getting it. If both parents have asthma, then the child has more than a 60% chance of having it. Asthma is more common in boys than girls until age ten, then it equals out.
Environment plays a huge role, since people can literally be allergic to anything. Asthma is much more common in industrialized areas. Some people just have seasonal symptoms, mostly in the spring. The unfortunate people have allergic symptoms and asthma all year long. Asthma is not something to sneeze about. Uncontrolled, it can be a very serious and life-threatening condition. Despite our armada of effective asthma drugs, the death rate of asthma among children rose 30% from 1980 to 1987 and continues to rise.
Welcome to Wheezin' Season. Wheezing is often described as a musical lung sound - a high-pitched squeak heard loudest during expiration, caused by the narrowed airways in the lower respiratory tract. The air goes in; but it can't easily get out. The body begins to compensate by increasing the respiratory rate in order to maintain adequate oxygen levels. Breathing is supposed to be effortless, but when a person wheezes, the body must work harder. Simple breathing becomes an exhaustive effort.
Although many areas claim to be the Allergy Capitol of the World, I think Sacramento Valley is definitely a top contender. The heavy rains caused everything to bloom at once. Pollen complete covers my car at work and you can see billions of particles floating in the air from the headlights. When I watched the news in the morning, the daily pollen count put trees at the top of the list. I knew it would be a busy day at the clinic. Fourteen hours and a half-dozen kids on nebulizers and one hospital admission later, I was right.
During the Wheezin' Season, children (and parents) frequently miss school and work. The ERs are crowded and there is often a shortage of hospital beds in some areas. People carry their inhalers, take steroids, and avoid all outdoor activities during the high pollen times.
I have always considered myself a medication minimalist, but when you treat asthma, you need a pharmaceutical armada and it is a medical art to fine-tune these needed drugs. It is not unusual to have people taking six or more different medications to control their asthma. Asthma treatment is very individualized. These are just two of the many drug types that are used:
Bronchodilators: Relaxes and expands the air passageways. Fast-acting beta-agonists, such as albuterol (Proventil, Ventolin), are considered "rescue drugs" and are often used by asthmatics that have infrequent or exercise-induced symptoms. People with asthma who are frequently using their inhalers are NOT IN CONTROL.
Antiinflammatory agents: Reduces airway inflammation. Steroids are the mainstay of asthma management, but people hate hearing the word "steroid", and think Barry Bonds or thick-forehead body-builders. Allergies and asthma cause profound inflammation, and steroids are often the best medication to manage it. There are many different types and strengths, and can be taken orally, by injection, by hand-held inhaler, or by nebulizer. Like most drug, steroids do have potential side-effects so it is vitally important for everyone to educate themselves about their asthma medications.
People do not become dependent on asthma medications. They are not like narcotics. Daily asthma medications are very important and may keep you out of the ER or hospital. Never take your asthma for granted. Always be prepared. Your GOAL is CONTROL.
Related Topics: Asthma Action Plan, WebMD Video: Suffering Seasonal Allergies?
Technorati Tags: allergy, asthma
Because spring in Northern California was delayed due to one of the wettest years on record, we made a jump in one week from infectious diseases to children with allergy. Earlier in the week, the runny noses started. The waiting room was filled with raccoon-eyed toddlers doing the "allergic salute". The allergic salute is a characteristic upward hand wipe of an itchy, runny nose. The raccoon eyes are also called "allergic shiners" - a bluish discoloration around the itchy, tearing eyes due to constant rubbing. Children have an itchy flair-up of eczema (atopic dermatitis). And, of course, the distinct sound of wheezing. When a person has itchy eyes, runny / itchy nose, AND audible wheezing, it has to be an allergic disorder.
All that wheezes is not necessarily asthma. Even simple viral infections (colds) can cause wheezing. An inhaled foreign body (not uncommon in children) can do it. Pneumonia and RSV (Respiratory Syncytial Virus) can do it. As a matter of fact, if you had a child that had RSV in infancy, this child has an increased risk of developing asthma.
Allergies and asthma runs in families, it is not unusual to see BOTH the child and the parent snorting, sneezing, and sniffing in perfect harmony. If one parent has asthma, the child has a 20% chance of getting it. If both parents have asthma, then the child has more than a 60% chance of having it. Asthma is more common in boys than girls until age ten, then it equals out.
Environment plays a huge role, since people can literally be allergic to anything. Asthma is much more common in industrialized areas. Some people just have seasonal symptoms, mostly in the spring. The unfortunate people have allergic symptoms and asthma all year long. Asthma is not something to sneeze about. Uncontrolled, it can be a very serious and life-threatening condition. Despite our armada of effective asthma drugs, the death rate of asthma among children rose 30% from 1980 to 1987 and continues to rise.
Welcome to Wheezin' Season. Wheezing is often described as a musical lung sound - a high-pitched squeak heard loudest during expiration, caused by the narrowed airways in the lower respiratory tract. The air goes in; but it can't easily get out. The body begins to compensate by increasing the respiratory rate in order to maintain adequate oxygen levels. Breathing is supposed to be effortless, but when a person wheezes, the body must work harder. Simple breathing becomes an exhaustive effort.
Although many areas claim to be the Allergy Capitol of the World, I think Sacramento Valley is definitely a top contender. The heavy rains caused everything to bloom at once. Pollen complete covers my car at work and you can see billions of particles floating in the air from the headlights. When I watched the news in the morning, the daily pollen count put trees at the top of the list. I knew it would be a busy day at the clinic. Fourteen hours and a half-dozen kids on nebulizers and one hospital admission later, I was right.
During the Wheezin' Season, children (and parents) frequently miss school and work. The ERs are crowded and there is often a shortage of hospital beds in some areas. People carry their inhalers, take steroids, and avoid all outdoor activities during the high pollen times.
I have always considered myself a medication minimalist, but when you treat asthma, you need a pharmaceutical armada and it is a medical art to fine-tune these needed drugs. It is not unusual to have people taking six or more different medications to control their asthma. Asthma treatment is very individualized. These are just two of the many drug types that are used:
Bronchodilators: Relaxes and expands the air passageways. Fast-acting beta-agonists, such as albuterol (Proventil, Ventolin), are considered "rescue drugs" and are often used by asthmatics that have infrequent or exercise-induced symptoms. People with asthma who are frequently using their inhalers are NOT IN CONTROL.
Antiinflammatory agents: Reduces airway inflammation. Steroids are the mainstay of asthma management, but people hate hearing the word "steroid", and think Barry Bonds or thick-forehead body-builders. Allergies and asthma cause profound inflammation, and steroids are often the best medication to manage it. There are many different types and strengths, and can be taken orally, by injection, by hand-held inhaler, or by nebulizer. Like most drug, steroids do have potential side-effects so it is vitally important for everyone to educate themselves about their asthma medications.
People do not become dependent on asthma medications. They are not like narcotics. Daily asthma medications are very important and may keep you out of the ER or hospital. Never take your asthma for granted. Always be prepared. Your GOAL is CONTROL.
Related Topics: Asthma Action Plan, WebMD Video: Suffering Seasonal Allergies?
Technorati Tags: allergy, asthma
22 Comments:
Yes, it is important to educate yourself on side effects of steroids for asthma, like Advair.
I used it, the lowest dosage, for three months last year and followed the directions to the letter. Yeah I got to breathe, but I have been plagued by recurrent yeast infections since then. Never had one before. I think I would have preferred the wheezing.
Your article is very biased and unbalanced. Tell the whole story about allergy and asthma medications. There are many alternative treatments for asthma, like leukotriene blockers, that are just as effective as steroids with minimal side-effects.
I do not agree with some of the above statements. Dr. Moser specifically stated that these were just 2 of the drugs that are often used for asthma. That is not biased, just an abbreviated list.
And by the way, leukotriene blockers only work for approximately 50% of those who try them, so for many people they are not "just as effective as steriods".
Advair is an inhaled steriod and yes, can cause oral yeast infections/thrush. The amount of steriod that actually enters the bloodstream is very limited and disappears fairly quickly (which is why you have to use is so often.) I find it extremely hard to believe that it is causing your yeast infections a year later.
Actually, I find it entirely believable that Advair has caused this. Not all pharmacists or Doctors will warn you that for this and many other orally inhaled meds you need to vigorously wash out your mouth after taking these meds or this is exactly what happens.
I tend to carry a small bottle of mouthwash in my bag for those cases where I get stuck out and about and need to take my inhaler - the aftertaste of the inhaler sometimes can be just awful.
A yeast infection in your mouth can be avoided by rinsing after using your steroidal medications. Yeast won't kill you....asthma can. Please stay on your prescribed medications.
Yes, there are many alternatives to managing asthma, and it should always be individualized. I am not biased in favor of steroids...it is just that steroids are the MOST EFFECTIVE.
Thank you for those wonderful comments....
Actually I have a question...do you know anything about using steroids for treating croup? My 13 month old has had croup 3 times in the past four months and may even have it again. One of the Pediatricians in his doctors office said to put him on a breathing treatment of steriods to prevent croup.
My question is if taking that steriod breathing treatment is actually better for him than him getting croup. From the research I've done, the negative side affects of steriods are pretty bad and treating croup at home is pretty safe. But, I am just looking for thoughts on this! Thanks
My 5 year old has recurrent croup for about 4 years now. He has taken oral steriods several times. (25 times) It seems to be the only thing that works for him when the croup gets so severe. They now think he has chronic sinusitis contributing to this according to a recent CT Scan. Thay also tell me he has asthma. He possibly has acid reflux. I am so confused, but meanwhile my son is constantly on orapred. He is sick 1-2 times a month. He currently takes Advair, singular, and rhinocort. I am confused about his condition. Any advice?
My husband (68, retired & a glofer)uses low dose Advair (250/50) once a day with good control of his wheezing. He also takes Theophylline ER 200mg twice a day and has a Rx for a rescue inhaler which he has not used since starting on Advair. He does not have any side effects but wonders if his recent problems with back pain (spasms) has anything to do with the steroids. maggie
I am looking for answers too about the continued use of steroids for my 6 year old son's reoccuring croup. He was just given his third prescription of predisolone in one month to treat his croup. He has been treated for asthma for about the last 3 years with singular, flovent, zyrtec, and nasonex. His asthma is under control, but the croup keeps coming back!! I'm scared to keep giving him steroids, but I do not know what else we can do for him. Please advise!!
My son is in a similar situation. He is 6 years old has been getting the croup since he has been 2. His croup is so severe and is always on a steroid and racine and xopenex.He starts with the croup and with severe stridor where he cant breathe. I think he has acld reflux but not sure. He had the croup about 12 times last year from october till may and already 3 x's this year starting in october. Any Advice????????? I don'y know what else to do.
My 13 year old daugher has had Croupe about 6 monthes ago and she now has this deep cough that sounds like a fog horn and it woln't stop.Advice?
My 9 month old son has had croup for 3 days now, and the doctor doesn't seem concerned at all, I spoke to him over the phone. He said to take him outside when it gets bad, and to use a cool mist humidifier. That the symptoms get worse at night.
My son can't breathe, we're taking him outside once an hour. This is my third child...so it's not first time mom jitters. He's had to be held all day long. Because upright is the only way he can breath. I'm just trying to keep him from crying so that things don't swell up worse than they are.
My doctor is anti-medicine, and sometimes it drives me crazy!
I have a nebulizer, and medicine...from my other two (ages 2 & 3 now) having bouts with RSV last winter. I've done a nebulizer treatment with just saline, and that helps a little. Could I use the actual medicine? My daughter was the same weight he is now when the medicine was prescribed.
Acutally my husband (who has been holding him for the better part of 48 hours) made an executive decision and gave him the treatment...and now he's sleeping like a baby...first time in 2 days!!!
I am at the right board I guess. My son 6 years old has croup every 2-3 weeks. For 3+ years. Every time he gets a sniffle, he ends up coughing for hours on end with croup. He is constantly on orapred, xopenex, pulmicort, singulair. The new asthma doc wanted him on Advair, but it has way to much negative feed back. Hes had CT of throat, no narrowing. Tonsils, adenoids out. Last month 12/07 we went to er expecting croup, now pneumonia in one lung. Hes been test for Cystic Fibrosis...negative. We do steam, humidifiers, allergy control, got rid of our doggie, everything. He has been told he has deviated septum. Now what. Please help! ericjay22@frontiernet.net
My 6 year old son has had recurring bouts of asthna and croup since he was a baby. An ENT specialist told me that Asthma is an allergic reaction in the chest and croup is allergic reaction in the throat and sinusitis = allergic reaction in the nose. Steroids stops the bodies allergic response. Preventation is the key. I even found food chemicals like preservatives and colourings trigger my son's croup and we can control it quite well by avoiding these as well as de-dusting his environment. Be careful of colourings and preservatives in medicines also. They can aggravate it. MUM FROM AUSTRALIA
Mum from Australia again: I just thought I would share something else. My son also had eczema from head to toe when he was younger which is allergic reaction on the skin. After keeping a food diary for a few weeks I discovered it could be juice. As soon as we took him off juice the eczma cleared up and never returned.Now juice and orange flavourings seem to trigger
his croup. So we tried to avoid it as much as possible.
I hope this might give other parents clues to what could be triggering their childrens croup and asthma. Look at food triggers also. Some doctors will say this is crap but I trusted my instinct and it has worked for my son. Hope this helps!
I have been taking advair for my asthma for three years and have suffered repeated bouts of chest colds and upper respitory infections, that I never experienced before taking this med. This last year I got the same chest cold symptoms recurr three times in the course of three months. This has never happened prior to using advair. When I went to see my pharmacist to ask her if the Advair side effects could have anything to do with it, she said that I should get off it immediately because while it does work to reduce inflammation in your airways, it weakens your immune system significantly. I'm sticking with the singulair (no steriod), cutting out the advair and looking for other natural remedies.
I wheeze at night mostly and have a cough while wheezing throughout the day. Feels like I have a chest cold. Is this asthma?
My 6 year old has had a cough that will last for a week with only a few days in between. We moved from Oklahoma to Arizona last year and he seemed to get better when we moved here then went downhill when we moved into a new apartment. He has been on prednisone, flovent, singulair, xopenex, and now he is on advair. He is supposed to take one puff 2x day advair, singulair 1x night, and xopenex inhaler for rescue. I want to know what is wrong with my son. My son is also on an allergy treatment Allergy Easy and so far I do not know what if anything that the medication is doing. It seems as though the flovent worked with the singulair to some degree but did not truely hit the symptoms. Now only being on the advair for two days and singulair I am leary of what is to come for my babys future. I have read so much literature on advair and most has been negative feedback. Anyone with information would be appreciated. Neither my husband or I have asthma, but when my son was younger he was around cigarette smoke and mold. No one has smoked around him for the last year and the mold seems to be seasonal with the winter months here in Arizona. Oct 07 - April 08 so far he has been sick almost all month every month. Need more feedback.... Asthma seems to be root cause, but I do know know much about the disease. My son is now seeing a allergy and asthma specialist, but I still feel like I am in the dark... maybe advair will work, but at what risks???
My family history:
We are vegetarians, non-smokers, non-alchoholic. My father has asthma since his youth.
After my son was born, he started getting asthma symptoms from the age of 2. Now he is 3 1/2 yrs old. He had been suffering after frequent ear infection and Pneumonia(atleast once a month).
When i took him for a vacation for a month to India, he was absolutely fine. absolutely no crouping or sickness. Right after we were back home to NY-longisland, he was struck by another pneomonia, coughing and ear infection.
Doctors say he will be fine in couple of years!! and may be Day care/school doesnt fit him now or LI is allergic to the core.
last week he got an ear infection. he is ofcourse better now(antibiotics are working), Am not sure how he will be after antibiotics are done. still hoping not to giveup.
he is under pulmicort 2wice a day inhaler and singulair once a day.
And now, am stuck with an Asthma too. mm... when ever my son is sick, am sick too. i am under advair 250mg and nasocort.
But i dont have a severe asthmatic wheezing like my father. I am afraid abt the sideaffects of advair. bcas after started increasing the advair from 150 to 250, i got an ear infection and i could hardly hear anything from my right ear.
Is this something any of you experienced? Am now worried to continue advair.
pls. suggest.
My six yr old is sick every 4 to 6 wks with cold like symptoms which lead to an ear infection or bronchitis. The majority of the time a family member is also sick or is sick within a week, so I tend to think they are colds. He is taking allegra 2x day and veramist once a day. He has allergies to mold, most grass, and cats. The allergist wanted to do allergy shots, but my husband was totally against them at this point.He takes allegra 2 x day and veramist once a day. We have tried other nasal sprays and singular with no real difference in symptoms. He is currently taking Flovent 2x day, because he had bronchitis and had some wheezing. If he has another ear infection in the next little while, we are going to the ENT. I just want to know how to keep him well and not sick every 4 weeks with a cold that lead to an ear infection or bronchitis and antibotics. He has at least one round of antibotics every month. He rarely has a runny nose. He does the allergic salute all the time and pinches his nose alot. I am constantly saying keep your hands off your nose.
My son is 7 years old and has been coughing on and off for about 3 months. Original doctor said don't worry....he is fine & it will go away in 10 days. Well it didn't...his doctor is anti-medicine....finally I got feed up & switched doctors. The new doctor said he's got pre-asthma conditions....prescribed all kinds to inhalers for day & night, an antibiotic, and a prescription of prednisone. His lung x-ray is clear as I was told. After the prednisone....he got better for like for a month...then caught a cold & the coughing came back. It's not a wheezing cough...his cough is "wet"...it sounded very congested/ as if a bag of mucus is lodged in his throat. I just don't know what to do....HELP!!!! I really do not think that he is being diagnosed correctly....I know my child....whenever he blows his nose...the phlegm is greenish....took him back to the doctor again...it doesn't really alarmed them much & send us home w/ NOTHING!!!! The coughing got worst, another doctor was able to see my son on a last minute appointment. This time...she said we need to know if the coughing is due to allergies/sinus or wheezing/dry cough....doesn't seemed to interested in anything I tell her...she just went on with her "educated" self. She gave him a prescription of antihistamines/decongestion....and an antibiotic if necessary. After all that ....he is still coughing..just a bit less/ but now....some of his cough is dry/wheezing like..and will cough until he gags..I'm EXTREMELY FRUSTRATED & SAD....I do not know what to do........I just want my baby to get better....I hate to see him suffer....I rather be the one who is having this whatever is it instead of him. It is extremely difficult to fine QUALITY health care nowadays. It's all about the insurance & # of apts they can squeeze in. I'm sure the good ones are out there....I'm praying that I will be able to find a doctor match for my son.
Reading all of these posts has really made me sad! All of these poor children. I have a 4 1/2 year old son that gets sick for most of the winter. We feel lucky if there is a "good" week in between bouts. Just as many of you have written he gets a sniffle that would be a simple cold for any other family member and it turns into awful asthma or croup -like coughing. It is so bad at times that I am just scared for him because he cannot get his breath. We use a nebulizer with albuterol which offers just a small relief, and have a cough syrup with codeine !!! that we use when it is bad. Sometimes for 3 or 4 days at a time. The doctor has just started him on Allegra. We have yet to be on steroids this season because I am so scared of side effects. I had asthma as a child and all of the steroid use really had negative consequences. Let's just say I could be the bearded lady, and It took 10 years to get pregnant.
This breaks my heart to see my son so sick, and like all of you I do not know what to do. His 2 brothers (3 and 1) have not had the same symptoms.
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